Navigating Dental Malpractice Claims: Insights from Industry Experts Understanding policy coverages William Cole, a Senior Claims Adjustor with Crawford & Company, began his presentation with a high-level overview of his role which encompasses investigation, evaluation, and negotiation, while emphasizing the collaborative nature of his interactions with dentists to help resolve malpractice claims. Crawford & Company manages the initial claims process on behalf of Zurich Insurance Company of Canada for CDSPI’s Malpractice Insurance. When there is a claim “First, the incident that occurred actually has to involve the practice of dentistry, and we have seen cases where that’s not the case,” explains Cole. Incidents that are not covered under the policy include, but are not limited to, criminal acts, practicing without a license, prohibited treatments, unauthorized acts by employees while knowingly acting outside their scope of supervision, and abuse. In dentistry, providing quality care to patients is not just a commitment but also a cornerstone of the profession. Despite the best efforts and intentions of dental professionals, malpractice claims can arise, leading to significant financial and reputational consequences. To shed light on this crucial topic, CDSPI recently convened a panel of dental malpractice experts. Drawing from their insights and experiences, they offered valuable information on typical instances of malpractice, the claims procedure, and strategies for risk mitigation. Drawing from his experiences, Cole shared examples of common claims encountered in dental malpractice. From instances of procedural errors to challenges in obtaining informed consent, he also emphasized the importance of meticulous documentation, ef fective communication, and proactive risk management strategies. The claims process Upon receiving a claim, Cole’s role involves investigating the situation, clarifying details with the dentist and the patient, and evaluating the evidence to determine liability. “Sometimes we get into situations where we’re not sure whether there’s malpractice or not, andwewill sometimes hire independent dentists to review the case and give us their expert opinion, which is more of a tiebreaker.” But in all cases, there must be evidence of substandard care. 40 | 2024 | Issue 2
RkJQdWJsaXNoZXIy OTE5MTI=